Intracranial Haemorrhage Flashcards
What are the three kinds of spontaneous intracranial haemorrhage?
SAH- subarachnoid haemorrhage ICH- intracranial haemorrhage IVH- intra-ventricular haemorrhage
How does SAH present?
- Sudden onset severe headache
- Collapse
- Vomiting
- Neck pain
- Photophobia
What is the DDx of sudden onset headache?
- SAH
- Migraine
- Benign coital cephalgia
What are the clinical signs of SAH?
- neck stiffness
- photophobia
- decreased conscious level
- focal neurological deficit (dysphasia, hemiparesis, IIIrd nerve palsy)
- Fundoscopy- retinal or vitreous haemorrhage
CT brain may be negative if >_ days post SAH
It is negative in __% of patients who have bled
CT brain may be negative if >3 days post SAH
It is negative in 15% of patients who have bled
When is lumbar puncture safe?
In alert patient with no focal neurological deficit, no papilloedema, or after normal CT scan
What would be seen in LP post SAH?
Bloodstained or xanthochromic CSF tap (6-48hr)
How is cerebral angiography used in SAH?
Gold standard but may occasionally miss aneurysm fue to vasospasm
Describe CA in SAH
Seldinger technique via femoral artery. 4 vessel angiography with multiple views
What are the complications of SAH?
- re-bleeding
- delayed ischaemic deficit
- hydrocephalus
- hyponatraemia
- seizures
Rebleeding after SAH is often _____.
20% risk in first __ days
50% risk in first _ months
Rebleeding after SAH is often fatal.
20% risk in first 14 days
50% risk in first 6 months
What is the managment for rebleeding?
Endovascular techniques
Surgical clipping
What is DIND? When does it occur?
Delayed ischaemic neurological deficit
Occurs days 3-12 after stroke
How does DIND present?
Altered conscious level or focal deficit
What causes DIND?
Vasospasm
What is the management of DIND?
Nimodipine
High fluid intake ‘triple H therapy’
How does hydrocephalus present?
Increasing headache or altered conscious level
What is the treatment for hydrocephalus?
CSF drainage, LP, EVD, shunt
Describe hyponatraemia post SAH?
SIADH or cerebral salt wasting
Often transient
How is cerebral salt wasting managed?
DO NOT fluid restrict
Supplement sodium intake
Fludrocortisone
Post SAH the risk of seizures is _% acute and __% 5 year risk
Post SAH the risk of seizures is 3% acute and 10% 5 year risk
Intracerebral haemorrhage is bleeding into the _____ ______. __% are secondary to hypertension, 30% are due to ______ or _______ _______.
Intracerebral haemorrhage is bleeding into the brain parenchyma. 50% are secondary to hypertension, 30% are due to aneurysm or arteriovenous malformation.
What are the two causes of hypertensive intracerebral haemorrhage?
Basal ganglia haematoma
Charcot-bouchard microaneurysms
Where do Charcot-bouchard microaneurysms arise?
Small perforating arteries
What is the presentation of ICH?
Headache
Focal neurological deficit
Decreased conscious level
What is the treatment of ICH?
Surgical evacuation of haematoma +/- treatment of underlying abnormality
Non-surgical management
What is the prognosis of ICH?
Good- if small superficial clot and good neurological status
Poor- if large basal ganglia or thalamic clot with major focal deficit or deep coma
When does intraventricular haemorrhage occur?
With rupture of a subarachnoid or intracerebral bleed into a ventricle
What are AVMs?
Arteriovenous malformations
What usually happens in an AVM? Where are they usually located and what causes them?
Shunting of blood: arterio->venous
Usually intraparenchymal
Congenital
What can AVMs cause?
Seizures
Haemorrhage- intracerebral, subarachnoid, subdural
Headache
Steal syndrome
What is the treatment for AVMs?
Surgery
Endovascular embolisation
Stereotactic radiotherapy
Conservative
Weigh risks against benefits
